Department of Pediatrics, Division of Nephrology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th floor, Rm 11.9722, Toronto, ON, M5G 0A4, Canada.
Pediatr Nephrol. 2023 Dec;38(12):3923-3936. doi: 10.1007/s00467-023-05956-4. Epub 2023 Apr 13.
Acute kidney injury (AKI) is a complex syndrome which affects a significant proportion of hospitalized children. The breadth and impact of AKI on health outcomes in both adults and children have come to the fore in recent years with increasing awareness encouraging research advancement. Despite this, management strategies for most types of AKI remain heavily reliant on fluid and electrolyte management, hemodynamic optimization, nephrotoxin avoidance and appropriate initiation of kidney replacement therapy. Specific drugs targeting the mechanisms involved in AKI remain elusive. Recent improvement in appreciation of the complexity of AKI pathophysiology has allowed for greater opportunity to consider novel therapeutic agents. A number of drugs specifically targeting AKI are in various stages of development. This review will consider some novel and repurposed agents; interrogate the plausibility of the proposed mechanisms of action, as they relate to what we know about the pathophysiology of AKI; and review the level of existing literature supporting their efficacy. The evidence base, particularly in children, is limited.
急性肾损伤 (AKI) 是一种复杂的综合征，影响了相当比例的住院儿童。近年来，AKI 对成人和儿童健康结果的广泛影响和重要性日益凸显，这促使人们提高了认识并推动了研究进展。尽管如此，大多数类型 AKI 的治疗策略仍然严重依赖于液体和电解质管理、血流动力学优化、避免肾毒性药物以及适当开始肾脏替代治疗。针对 AKI 相关机制的特定药物仍难以捉摸。最近对 AKI 病理生理学复杂性的认识有所提高，为考虑新型治疗药物提供了更多机会。许多专门针对 AKI 的药物正在不同的开发阶段。这篇综述将考虑一些新型和再利用的药物；探究所提出的作用机制的合理性，因为它们与我们对 AKI 病理生理学的了解有关；并回顾现有文献对其疗效的支持程度。证据基础，特别是在儿童中，是有限的。
